多发伤合并颅脑损伤患者颅内血肿进展相关因素分析

Analysis of associated factors for progressive intracranial hemorrhage after brain injury combined with multiple trauma

目的探讨多发伤合并颅脑损伤患者颅内血肿进展相关因素。方法笔者回顾性分析2007年1月~2014年1月收治的134例多发伤合并颅脑损伤患者的临床资料,其中男性91例,女性43例;年龄16~60岁,平均（35.6±10.7）岁。其中30例血肿进展患者为进展组,104例为未进展组,利用统计学方法对两组患者性别、年龄、伤情、格拉斯哥昏迷评分（GCS）、创伤严重度评分（ISS）、创伤严重指数（IISI）、休克指数、手术、凝血状况、液体复苏及血压调控等因素进行单因素及多因素分析。结果两组在年龄、性别、GCS、ISS评分、IISI、6h内的平均动脉压、休克指数、开颅手术情况对比无统计学意义。两组患者治疗前后休克指数均明显改善,比较无统计学意义。颅内血肿进展与48h平均动脉压（OR=1.994,P〈0.001）、平均24h补液量（OR=0.342,P=0.038）、凝血功能异常情况（48h,OR=3.173,P=0.039）、多发脑挫裂伤情况（OR=2.921,P=0.041）相关。两组预后组间比较采用Ridit分析（R值_（进展）=0.590,R值_（未进展）=0.474,t=2.007,P=0.047）,未进展组好于进展组。结论多发伤合并颅脑损伤患者颅内出血是影响预后的重要因素,多发脑挫裂伤患者更易出现,应予重视,通过限制性液体复苏和早期血压目标管理有利于减少血压波动和凝血功能异常发生,对改善患者预后有一定益处。

Objective To study the factors associated with intracranial hemorrhage progression in brain injury patients combined with multiple trauma. Methods A total of 134 patients with brain injury and multiple trauma who were admitted into our hospital from Jan. 2007 to Jan. 2014 were retrospectively reviewed. There were 91 males and 43 females,with age ranging from 16 to 60（ 35. 6 ± 10. 7） years. They were divided into intracranial hemorrhage progression group（ IHP,30 cases） and non-intracranial hemorrhage progression group（ NIHP,104 cases）. The factors of progressive hemorrhage including age,gender,MAP,shock index,coagulation function,fluid resuscitation,GCS,ISS,TSI,operation,multiple brain contusion and laceration,were analyzed by statistical analysis. Results Between-group differences were insignificant with regard to age,gender,GCS,ISS,IISI,MAP（ 6h）,shock index（ 6h）,and operation（ P 0. 05）. The shock index was significantly improved after surgery,showing no statistical difference. Coagulation function（ 48 h,OR = 3. 173,P = 0. 039）,MAP（ 48 h,OR = 1. 994,P 0. 001）,24 h mean liquid capacity（ OR = 0. 342,P = 0. 038） and multiple brain contusion and laceration（ OR = 2. 921,P = 0. 041） were related to intracranial hemorrhage progression. At 6-month follow-up,the result of the NIHP group was better than that of the IHP group for GOS by Ridit analysis [Ridit（ IHP） = 0. 590,Ridit（ NIHP） = 0. 474,t = 2. 007,P = 0. 047]. Conclusion The intracranial hemorrhage progression is an important factor affecting prognosis. The patients with multiple contusion and laceration are likely to suffer progressive hemorrhage. Limited fluid resuscitation and initial blood pressure management could minimize blood pressure instability and coagulation disorders,reducing the probability of delayed intracranial hemorrhage,and further improving the outcome.